The Many Faces of Meckel's Diverticulum: Clinical Presentations and Complications.

Background Meckel's diverticulum (MD) is a congenital anomaly of the gastrointestinal tract characterized as a true diverticulum that contains all three layers of the intestinal wall. It is typically situated on the antimesenteric border of the terminal ileum and receives blood supply from the vitelline artery. Although often asymptomatic, MD can lead to complications such as intestinal obstruction, gastrointestinal bleeding, perforation with peritonitis, and, rarely, malignancy. Histologically, ectopic gastric and pancreatic tissues are the most commonly observed findings. Methods This retrospective study reviewed pediatric cases of symptomatic MD treated between June 2022 and May 2025. Data regarding clinical presentation, operative procedures, histopathological findings, and treatment outcomes were analyzed. Results The average age at presentation was 40 months, ranging from one to 60 months. Among the six children studied, two (33%) presented with umbilical discharge, and two (33%) had intestinal obstruction, one (16%) of whom had associated bowel gangrene. These four (64%) patients underwent laparotomy with ileal resection and anastomosis. One (16%) child presented with perforation peritonitis due to a ruptured MD and required an emergency ileostomy, later reversed after eight months. One (16%) child, who had intermittent lower gastrointestinal bleeding and anemia, underwent laparoscopy-assisted Meckel's diverticulectomy. Histopathology revealed ectopic gastric mucosa in five (84%) patients and pancreatic tissue in one (16%) patient; no malignancy was identified. Conclusion Prompt surgical resection with restoration of bowel continuity is crucial in cases of symptomatic MD. Although resection of incidentally discovered MD during unrelated abdominal procedures is sometimes considered due to its potential for future complications, including bleeding or malignancy, there is currently insufficient evidence to support the routine removal of asymptomatic MD in the absence of other abdominal pathology.